The differential diagnosis of acute loss of vision in children includes acute loss of vision due to
retinal or
optic nerve disease, and
cortical blindness. The
retinal disorders which may be mis diagnosed as
optic neuritis include Leber
neuroretinitis,
Leber hereditary optic neuropathy, and Stargardt
macular dystrophy.
Retinal changes which evolve in
neuroretinitis, and the
pseudopapilledema in Leber heredity
optic neuropathy are helpful in differentiating these disorders from
optic neuritis. Stargardt
macular dystrophy, a disorder associated with a variety of mutations, may be mis diagnosed as psychogenic visual loss due to the early normal appearance of the retina, and the loss of vision over a period of weeks. The differentiation of
optic neuritis from
anterior ischemic optic neuropathy (AION), depends upon the initial appearance of the optic disc (in AION either
hyperemia due to reperfusion, or swelling and pallor if total
infarction has occurred). The authors have described children with abrupt loss of vision during
renal dialysis, whose risk factors for AION included systemic
hypotension and intra
ocular hypertension. Children with vigorous treatment of accelerated
hypertension, and children with
migraine and pro thrombotic disorders have also incurred AION. Thus, AION should be suspected when acute loss of vision occurs in association with certain ocular and systemic risk factors. In children capable of cooperating for visual field examination, the typical change in AION is an altitudinal defect, while
optic neuritis it is a
central scotoma. The association of
optic neuritis with
multiple sclerosis,
DeVic disease, and with acute demyelinating1
encephalomyelitis require special consideration in regard to treatment and prognosis. Acute loss of vision due to cerebral cortical insults involves a large differential diagnosis which includes vascular, metabolic and infective disease; as well as disorders causing transitory
blindness such as
seizures and
migraine